Provider Demographics
NPI:1134536618
Name:SEGUIN, MARY
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:SEGUIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 W BIG BEAVER RD STE 1450
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4762
Mailing Address - Country:US
Mailing Address - Phone:248-244-8644
Mailing Address - Fax:
Practice Address - Street 1:888 W BIG BEAVER RD STE 1450
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4762
Practice Address - Country:US
Practice Address - Phone:248-244-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-17
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801095875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker